Getting value for our health care dollars

A patient who gets more medical tests and procedures than the next person for a similar diagnosis doesn’t necessarily mean the first patient received better medical care. It does, however, mean the first patient will get a higher bill.

For the most part, that’s how our current health care system works. The more tests and procedures patients get, the more money doctors and hospitals make, even if the patients’ health doesn’t improve.

But is that really how we want our health care system to work? Wouldn’t it be better if doctors and hospitals were paid based on whether they produce healthier outcomes for their patients?

That idea is not so far off. In fact, pay-for-performance is being tried in hospital systems around the country, including at Aurora Health Care in Wisconsin.

Milwaukee-based Aurora is among several hospital systems nationwide that have been voluntarily participating in projects aimed at reducing inefficient practices (like ordering unnecessary medical tests) that increase costs but do nothing to improve patient care.

Last week, Aurora was recognized as a “top performer” in the second year of a three-year national project to improve the quality of patient care while at the same time lowering costs. Known by the acronym QUEST, the national project involves 157 not-for-profit hospitals that are trying to reduce inefficient practices. The project is organized by Premier, a Charlotte, N.C.-based organization focused health care quality improvement.

QUEST participants have agreed to share with each other their best ideas at making their hospitals safer for patients, improving medical care quality and reducing costs. The hospitals identified the main drivers that lead to unnecessary deaths, errors, improved patient experience and excessive costs, then they try to improve in those areas. The hospitals measure their progress and share with each other what works best.

According to Premier, the project has saved 22,164 patient lives and reduced inflation-adjusted costs by $2.13 billion, or about $400 per patient, in its first two years.

“Improving quality is an ongoing commitment for us at Aurora,” says Dr. Nick Turkal, Aurora’s president and CEO. “It is an important part of our value equation and a proven way to contain costs.”

Dr. Nick Turkal

While Aurora doesn’t make public the details of its quality improvement data, Aurora does have contracts with some insurers where payment is structured around such performance goals, explains Jacqueline Gisch, who directs Aurora’s quality improvement programs.

“As an organization, Aurora feels strongly that it is important that we be paid for providing high quality care, not just for doing more (tests and procedures),” Gisch says.

Aurora has been involved in other voluntary efforts that tie pay with performance. One is a pilot project involving the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare for the elderly and Medicaid for the poor.

Under that pilot project, hospitals that reach quality improvement targets qualify for bonus payments from CMS. As of a year ago, CMS awarded $12 million in extra payments to a total of 112 hospitals, including $365,000 to Aurora.

The CMS and QUEST projects are examples of how health care organizations like Aurora are trying to reform health care on their own. Opponents of the new federal health reform law argue that these voluntary pay-for-performance and quality improvement activities are just more proof that the law is unnecessary government intrusion into American medicine. (For the record, Aurora did not take a position on the reform bill.)

Still, when detailed data on quality improvement projects aren’t shared with the general public, it’s hard for average citizens to know if they’re really getting their money’s worth when it comes to health care.

While such big picture policy issues may be out of our individual control, there is one thing we patients can do to see how serious our doctor or hospital is about quality: Start asking more questions. When your doctor prescribes a bunch of medical tests, ask what each test is for and how it will improve your health.

If the doctor can’t answer or seems offended by your questions, it’s time to find a new doctor.

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